Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, South Korea.
Department of Medicine, Kosin University College of Medicine, Busan, South Korea.
Laryngoscope. 2021 Feb;131(2):448-452. doi: 10.1002/lary.28835. Epub 2020 Jun 20.
Application of transcartilage needle electrode for intraoperative neuromonitoring (IONM) during thyroidectomy has been considered an alternative method of electromyography (EMG) tube recording. However, needle electrodes must be inserted into both sides of the thyroid cartilage with exposure of the cartilage lamina. We sought to evaluate the feasibility of applying a single ipsilateral transcartilage needle electrode for IONM during unilateral hemithyroidectomy.
Thirty-four patients underwent IONM during unilateral thyroidectomy. A dual disposable needle electrode was inserted obliquely into the inferior lower third of the ipsilateral lamina of the thyroid cartilage. Patients were classified as deep (≥ 5 mm) or superficial (< 5 mm) by the depth of the needle electrode inserted into the thyroid cartilage. Without using an EMG tube, IONM was done according to the standardized procedure using a single needle electrode only.
IONM was successful in all nerves at risk. Amplitude of the EMG signal was stable during the surgery, with no cases presenting loss of signal. Amplitude of the signal from vagal and recurrent laryngeal nerve stimulation was significantly lower when needle insertion was superficial (< 5 mm). None of the patients showed postoperative vocal cord paralysis, and complications related to needle electrode were not identified.
IONM using a single ipsilateral transcartilage needle electrode during unilateral hemithyroidectomy was feasible with no significant complications. It may serve as an alternative method of IONM with the advantage of minimal exposure of the thyroid cartilage lamina.
4 Laryngoscope, 131:448-452, 2021.
在甲状腺切除术期间应用经软骨针电极进行术中神经监测（IONM）被认为是肌电图（EMG）管记录的替代方法。然而，针电极必须插入甲状腺软骨的两侧，暴露软骨板。我们试图评估在单侧甲状腺叶切除术中应用单侧经软骨针电极进行 IONM 的可行性。
34 例患者在单侧甲状腺切除术期间进行 IONM。将一次性双针电极斜插入同侧甲状腺软骨板的下下三分之一处。根据针电极插入甲状腺软骨的深度将患者分为深部（≥5mm）或浅部（<5mm）。不使用 EMG 管，仅使用单个针电极根据标准化程序进行 IONM。
所有高危神经的 IONM 均成功。在手术过程中，EMG 信号的幅度保持稳定，没有信号丢失的情况。当针插入较浅（<5mm）时，迷走神经和喉返神经刺激的信号幅度明显较低。没有患者出现术后声带麻痹，也未发现与针电极相关的并发症。
在单侧甲状腺叶切除术中使用单侧经软骨针电极进行 IONM 是可行的，没有明显的并发症。它可以作为 IONM 的替代方法，具有最小化甲状腺软骨板暴露的优点。
4 Laryngoscope, 131:448-452, 2021.
